Use Of Laparoscopic Ultrasonography Research Articles

9959 Use of Laparoscopic Ultrasound during Robotic Multiple Myomectomy

9959 Use of Laparoscopic Ultrasound during Robotic Multiple Myomectomy

Use of Laparoscopic Ultrasonography in Surgical Procedures of Hepatobiliary and Pancreatic Diseases

Brief Description of the Purpose of the Report: The aim of our report is to describe the typical ultrasonographic features of gallbladder infestation by Clonorchis sinensis. Medical History: A 34 year-old-man, recently returned from China, was hospitalized for fever, jaundice and epigastralgia. He reported an ingestion of Yusheng, a Chinese raw fish salad. Objectively, he had fever and positive Murphy’s sign. Laboratory workout documented an increase of inflammatory and cholestasis markers. Ultrasound showed a distended gallbladder with thickened walls and lumen occupied by stratified material compatible with biliary sludge. In the dependent portion of the gallbladder, a flocculent, nonshadowing and floating group of echos was appreciated. It changed in position in reaction to a light blow with the transducer. Diagnosis: The sonographic aspects were consistent with previous reports of gallbladder infections by Clonorchis sinensis [1]. The report was confirmed by a stool examination, positive for Clonorchis sinensis. After treatment with mebendazole, the patient became asymptomatic. Discussion and Summary of the Case: The gallbladder involvement by parasites is unusual, but should be considered in the differential diagnosis in the presence of a suggestive history and typical sonographic features. Early medical treatment is associated with a rapid clinical improvement, thus avoiding any surgical approach.

The Prevention of Major Bile Duct Injures in Laparoscopic Cholecystectomy

Major bile duct injury (MBDI) is one of the most serious complications associated with laparoscopic cholecystectomy (LC). This study reports our experience in preventing MBDI during LC. Between September 1991 and August 2004, 13,000 cases of LC were performed at Kunming General Hospital. Systemic strategies, including selection of proper patients for LC based on the surgeons' experience, dissection techniques in Calot's triangle, selective use of laparoscopic ultrasonography, and indication of conversion to an open approach were developed and introduced to avoid MBDI. In our series, the overall incidence of MBDI was 0.085%, 0.60% (3 of 500) over the first period from September 1991 to September 1992, 0.17% (5 of 3000) over the second period from October 1992 to September 1996, and 0.03% (3 of 9500) over the third period from October 1996 to August 2004. The MBDI included transection of the common bile duct (CBD) due to mistaking CBD for cystic duct (n=6), cautery injury (n=3), laceration of the CBD at the junction of cystic duct and CBD (n=1), and clip partially of common hepatic duct due to blind hemostasis (n=1). The incidence of MBDI in our institution is acceptable. We believe the system strategies are effective to avoid MBDI in LC. LC is a safe procedure with an incidence of biliary injury comparable with that for open cholecystectomy.

Laparoscopic Surgery in Patients With Sporadic and Multiple Insulinomas Associated With Multiple Endocrine Neoplasia Type 1

There have recently been reports of a limited number of laparoscopic procedures in patients with clinically manifest hyperinsulinism. However, the precise role of laparoscopy remains unknown. Between January 1998 and September 2003, 11 consecutive patients (10 women and 1 man; mean age, 40 years; age range, 22-66 years) with sporadic insulinoma and two female patients (25 and 40 years old) with multiple insulinomas associated with multiple endocrine neoplasia type 1 (MEN-1) were operated on using the laparoscopic approach. Endoscopic ultrasonography was used to localize the tumor preoperatively in 90% of patients with sporadic insulinoma. In patients with MEN-1, computed tomography and octreoscan-(111)In demonstrated multiple tumors. Laparoscopic ultrasonography (LapUS) was performed in all patients for operative decision-making. Of 11 patients with sporadic insulinoma, laparoscopic enucleation (LapEn) was planned in 8 patients, but in 1 patient, the use of LapUS missed the tumor and the patient was converted to open surgery. Mean operating time after LapEn (seven patients) was 180 minutes, and the mean blood loss was 200 ml. The mean hospital stay was 5 days. In three of the 11 patients, laparoscopic spleen-preserving distal pancreatectomy (LapSPDP) was performed; the mean operative time was 240 minutes, and the mean blood loss was 360 ml. Postoperative complications occurred in three of seven patients after LapEn (three pancreatic fistulas managed conservatively, and one case of bleeding requiring reoperation). LapSPDP was performed in both patients with MEN-1; in one patient with splenic vessel preservation (SVP), the operating time was 210 minutes and blood loss was 650 ml, with a hospital stay of 6 days. In another patient without SVP, the operating time was 150 minutes and blood loss was 300 ml. The latter patient developed a 4-cm splenic infarct managed conservatively, and the hospital stay was 14 days. LapEn and LapSPDP are feasible and safe and achieved cure in patients with sporadic insulinoma and multiple insulinomas associated with MEN-1. However, the risk of pancreatic leakage after LapEn remains high, and LapSPDP without SVP may be associated with splenic infarct.

Laparoscopic Pancreatic Surgery for Islet Cell Tumors of the Pancreas

The experience with laparoscopic pancreatic surgery (LPS) in general, and pancreatic islet cell tumors (ICTs) in particular, is still limited. Because insulinoma is the most prevalent tumor and is mostly benign, single, and curable with surgical excision, it comprises most of the cases. Our experience with 17 cases (10 insulinomas, 2 gastrinomas, 1 nesidioblastoma, 4 nonfunctioning tumors) and those recorded in the literature (93 cases) show that laparoscopic surgery for small, solitary benign islet cell tumors located in the body and tail is feasible and safe and can result in rapid postoperative recuperation and a complication rate comparable or lower than that achieved with open surgery. It duplicates the success rate seen with conventional surgery regarding intraoperative localization and cure of disease. The main morbidity continues to be the occurrence of a fistula (18%), most often after enucleation, but the clinical course is benign in most instances. Preoperative imaging studies are required for localization, and the combined use of biphasic helical computed tomography and endoscopic ultrasonography (US) seems to be cost-effective. The use of laparoscopic US is an integral part of the laparoscopic procedure, and the information achieved is valuable for both confirming localization and decision making concerning the most appropriate surgical procedure. In cases of distal pancreatectomy, splenic salvage, preferably with preservation of splenic vessels, is feasible albeit more demanding and can be achieved in most cases.

Laparoscopic ultrasonography for resection of insulinomas

Background. There have been few reports on the use of laparoscopic ultrasonography as an aid for the resection of insulinomas. In this study, we review our experience with laparoscopic ultrasonography for the intraoperative localization and resection of insulinomas. Methods. We attempted laparoscopic resection of insulinomas in 7 patients (median age, 50 years) during a 4-year period. Preoperative imaging showed that 1 of the insulinomas was located in the head of the pancreas, 2 were located in the body, and 4 were located in the tail. Results. We identified the insulinomas in all 7 patients with laparoscopic ultrasonography. In 6 of the patients, the insulinomas were laparoscopically resectable, either by enucleation (4 patients) or by resection of the pancreatic tail (2 patients). Conversion to laparotomy was necessary for the insulinomas in the head of the pancreas because they were close to the portal vein and the major pancreatic duct. All patients showed improvement in their hypoglycemia after the operations. Minor leakage of pancreatic juice occurred in 4 patients, and this was resolved with conservative treatment. Conclusions. Laparoscopic ultrasonography is useful for the intraoperative localization of insulinomas. Laparoscopy is a safe and feasible technique for resecting insulinomas located in the body or tail of the pancreas. (Surgery 2001;130:1086-91.)

Laparoscopic ultrasonography.

The use of laparoscopic ultrasonography (LUS) allows visualization of tissues beyond the two-dimensional laparoscopic picture, enhancing the amount and quality of information available to the surgeon. Linear-array transducers with frequencies of 7.5 to 10 MHz are typically used for LUS, employing B-mode scanning and color Doppler capability on probes with articulating tips. In general surgery, LUS has become a common adjunct to the intraoperative staging of upper gastrointestinal malignancy to determine resectability, avoiding unnecessary laparotomy. In urology, LUS appears to be a promising adjunct for four current procedures: difficult pelvic lymphocele marsupialization, renal cyst decortication, nephrolithotomy and other renal stone surgery, and cryotherapy of renal masses. The role of LUS during varicocelectomy is limited, and enthusiasm for this procedure is waning. Laparoscopic ultrasonography is a critical adjunct to renal cryoablation, a developmental procedure that currently lacks long-term data but is promising as therapy for small, incidentally detected renal masses. It appears that as laparoscopic urologic procedures continue to expand, so will the application of this promising operative imaging modality.

Laparoscopic ultrasonographic appearance of the common bile duct mucosa: a predictor of choledocholithiasis.

Previously we reported on the use of laparoscopic ultrasonography in detecting common bile duct stones during laparoscopic cholecystectomy. The aim of this study is to describe the laparoscopic ultrasonographic appearance of the common bile duct mucosa in patients with choledocholithiasis. Medical records of 44 patients with an increased risk for common bile duct stones undergoing laparoscopic cholecystectomy between 1993 and 1998 were reviewed. In the operating room, the laparoscopic ultrasonographic appearance of the common bile duct mucosa was scored in real time as normal, mild changes (hyperechoic mucosa), or severe changes (hyperechoic with mucosal thickening). Of the 31 patients (70%) with stones or sludge in the biliary tree, 29 (94%) had either severe (58%) or mild (36%) hyperechoic and 2 (6%) had normal-appearing common bile duct mucosa on laparoscopic ultrasonography. Of the 13 patients (30%) with no documented stones or sludge, 11 (85%) had normal and 2 (15%) had mild hyperechoic common bile duct mucosa on laparoscopic ultrasonography. Both of these patients had laboratory values indicating recent passage of common bile duct stones. The association between common bile duct stones and the presence of hyperechoic common bile duct mucosa was statistically significant (P < .0001, Fisher's exact test). This is the first report of hyperechoic common bile duct mucosa demonstrated by laparoscopic ultrasonography as a predictor of common bile duct stones. This finding is evident in the majority of patients with common bile duct stones and also may be associated with recent passage of a stone into the duodenum.

New Development of Laparoscopic Ultrasound and Laparoscopic Pelvic Lymphadenectomy in the Management of Patients with Cervical Carcinoma

Objectives.The objectives of this study were to evaluate the use of laparoscopic ultrasonography (USG) in combination with laparoscopic pelvic lymphadenectomy in the management of patients with cervical carcinoma.Methods.A technique for detecting pelvic and para-aortic lymph node metastases through laparoscopic USG was developed. Laparoscopic USG was done prior to pelvic lymphadenectomy performed either laparoscopically or by laparotomy. Laparoscopic USG findings were compared with pathologic findings.Results.The sensitivity and specificity of laparoscopic USG in detecting pelvic lymph node metastases were 91 and 100%, respectively. Metastatic pelvic lymph nodes could be completely removed through laparoscopes in 7 of 11 patients, with no complications.Conclusion.Laparoscopic USG is highly sensitive in detecting metastatic pelvic lymph nodes. Detection and removal of metastatic pelvic lymph nodes laparoscopically allow quick recovery from the operation and early commencement of radiotherapy.